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Hyperglycaemia during exacerbations of asthma and chronic obstructive pulmonary disease

Authors

  • Heikki O Koskela,

    Corresponding author
    1. Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
    • Correspondence

      Heikki O. Koskela, MD, Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, PL 1777, 70211 Kuopio, Finland

      Tel: +358 44 717 2795

      Fax: +358 17 17 3993

      email: heikki.koskela@kuh.fi

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  • Päivi H Salonen,

    1. Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
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  • Leo Niskanen

    1. Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland
    2. School of Medicine, Institute of Clinical Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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  • Authorship and contributorship

    HK designed the study, helped to recruit the subjects, analysed the data and wrote the manuscript.

    PS designed the study, mainly raised the funding, mainly recruited the subjects, uploaded the data to the computer, partly analysed the data and has been involved in the drafting of the manuscript.

    LN designed the study, partly analysed the data and has been involved in the drafting of the manuscript. All authors have given final approval of the version to be published.

  • Ethics

    The present study has been reviewed by the Research Ethic Committee, Hospital District of Northern Savo (75//2006) and it has been performed in accordance with the ethical standards laid down on the 2000 Declaration of Helsinki. All patients gave their written informed consent.

  • Conflicts of interests

    The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Abstract

Introduction

Hyperglycaemia is a well-known phenomenon among patients with an exacerbation of asthma or chronic obstructive pulmonary disease (COPD). It may be associated with increased risks of death and complications.

Objectives

To define the prevalence and determinants of hyperglycaemia in patients with an exacerbation of asthma or COPD.

Methods

This was a prospective, cross-sectional study including 153 hospitalised patients with an exacerbation of asthma or COPD. All received inhaled beta-2-adrenergic bronchodilators and oral glucocorticoids in internationally recommend doses. Plasma glucose was measured seven times during the first day. Hyperglycaemia was defined as fasting glucose >6.9 mmol/L or postprandial glucose >11.1 mmol/L. In addition, the family history for diabetes and the Karnofsky performance score were assessed. Height, weight, waist circumference, oxygen saturation, blood pressure, temperature and heart rate were measured. Glycosylated haemoglobin A1c (gHbA1c), C-reactive protein, leucocytes, urea and arterial blood gas values were analysed.

Results

Eighty-two per cent of the patients demonstrated hyperglycaemia, with similar prevalence between asthma and COPD. Of the 130 patients without a previous diagnosis of diabetes, 79% showed hyperglycaemia. In binary logistic regression analysis, high gHbA1c, high C-reactive protein and Karnofsky score less than 80% associated with the presence of fasting hyperglycaemia. High gHbA1c and current smoking associated with postprandial hyperglycaemia.

Conclusions

Hyperglycaemia is very common among hospitalised patients with an exacerbation of asthma or COPD. It is probably triggered by the medication and the patient's metabolic predisposition mainly determines its presence. Current smoking is the main treatable contributor to hyperglycaemia.

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